Flat feet (flatfoot, pes planus, fallen arches) occur when the arch in your foot drops, causing the bottom of your foot to flatten. This is easy to note, as the entire sole of your foot will contact the floor when you stand. In many cases, flat feet are hereditary and cause no pain.

But for those who once had arches, Flatfoot slowly develops from wear and tear (aging) or trauma, causing pain in the arches, heels, ankles, knees or hips, as the leg and foot fall out of alignment. The culprit is usually damage to the posterior tibial tendon which runs along the inside of your ankle - when it weakens, it can no longer support the arch.

Why you need your arches

We all start with zero arch. We're born with flat feet and slowly our arches develop during childhood, becoming fully developed in adulthood.

The arches and the biomechanics of the lower leg are intimately linked - our arches literally put a "spring" in our step, determine how we walk and distribute our body weight proportionally across our feet and legs. Arches also need to be sturdy and flexible to adapt to various surfaces. When the strength or flexibility of the arch fails, the alignment and balance of the foot and leg suffers.

What causes flat feet?

The most common cause of Adult Acquired Flat Foot Deformity (AAFFD) is damage to the posterior tibial tendon, one of the most important tendons in your leg. Starting at the calf, the posterior tibial tendon travels down the inside of your leg and heel, and attaches to the bones on the inside of your foot. The main function of the tendon is to support your arch and foot. If the tendon suffers chronic damage such as persistent inflammation, it may lose its ability to support your arch, and the arch will slowly collapse. Pain and discomfort from AAFFD can be substantial, occurring anywhere in the foot, heel, ankle, knee, back, or hip.

Inflammatory arthritis, especially rheumatoid arthritis, attacks the cartilage in the joints as well as the ligaments that support the foot. The inflammation causes not only pain, but also may change the shape of the foot and cause the arch to drop.

Ligament injury causes the joints to fall out of alignment. The job of the ligaments is to hold the bones in place and prevent them from moving. When the ligaments are damaged, the bones fall, flattening the arch.

Fractures or dislocations of the bones in the midfoot can lead to Flatfoot deformity.

Charcot Foot Disorder, a complication of diabetes, results from a nerve condition (diabetic peripheral neuropathy) which causes a loss of sensation in the feet. An infection in the foot, unknown to the patient, causes weakness in the ligaments and bones, leading to collapse of the arch and other complications. Complicated surgery is required to correct the problem.

Other reasons for developing Flatfoot include

• Obesity
• Muscle diseases
• Pregnancy
• Aging
• Trauma

Symptoms of Flatfoot depend on the cause of the condition, but may include :

• Difficulty standing or walking for long periods, and pain that gets worse with activity. High intensity activities such as running can be especially difficult.
• Pain or achiness occurring anywhere from the mid foot, heel and arch to the hip and back.
• Pain along the inside of the foot or ankle (path of the posterior tibial tendon). May be accompanied by swelling.
• Stiffness in the feet
• Feet tire easily
• Standing on toes is difficult
• Pain on the outside of the ankle, caused by a shifting heel bone which puts pressure on the fibula (ankle bone)
• In the presence of diabetes, patients may discover a lump on the bottom of their foot. This may develop into an ulcer and consequently Charcot foot disorder. Any difference in the top or bottom surface of the foot should immediately be brought to the attention of a podiatrist

Treatment for flat feet

• Custom orthotics may be prescribed to support your feet correctly and reduce pain
• A change in footwear: Your podiatrist may suggest you buy a pair of high quality, supportive shoes to reduce stress on your feet and support them correctly
• Physical therapy to stretch the Achilles tendon. A short Achilles can contribute to Flatfoot, and stretching it will improve flexibility in the foot
• Surgery may be recommended to repair the arch and improve flexibility

Watch the story of how we alleviated the pain of Flatfoot (and other conditions) for one of our patients.

Heel pain and ankle pain usually appear separately. But sometimes, pain in the heel and ankle can occur together as a result of one injury or multiple, associated injuries.

Overuse

Runners and other athletes are especially prone to overuse injuries in the heel and ankle. Some, especially those with long legs, are also prone to having a stiff Achilles tendon and stiff calf muscles. As the foot and ankle literally hinge on these mechanisms, inflexibility leaves the tendon, heel and ankle at risk of injury, especially when we play sports. Usually, the injury appears in the form of Achilles tendonitis, calcaneal (heel bone) bursitis, or plantar fasciitis.

If, at the first sign of pain you rest, elevate and ice the sore area until the pain subsides, healing may be achieved without medical intervention. If you ignore the pain and keep training, the injury may become very serious. If pain continues for 4 days or more, see a podiatrist.

Stress fracture

A stress fracture in the ankle or foot generally occurs gradually from overuse. Depending on the location and severity of the fracture, pain can radiate through the entire foot, ankle and/or heel. The pain may be accompanied by numbness or tingling, redness, swelling and a feeling of instability.

It's essential that any fracture  - whether a small stress fracture or a more serious break - be treated by a podiatrist to insure that it heals correctly. Don't blow it off - ask anybody who's middle aged or older and they'll tell you how much these "minor" stress fractures come back to haunt you later in life.

Nerve conditions

Tarsal Tunnel Syndrome and peripheral neuropathy can cause considerable pain and discomfort. Tarsal Tunnel is an entrapment of the posterior tibial nerve which passes through your ankle. When the nerve becomes compressed, pain can be felt from the sole of the foot and throughout the ankle. Pain may also radiate to the leg and hip. Peripheral neuropathy, usually a side effect of diabetes, can cause tingling and pain at any point in the foot and lower leg.

Both conditions require the intervention of a podiatrist to relieve symptoms.

Tendinitis, Tendinosis, or tendon rupture

In or near the ankle, the Achilles tendon is the most likely tendon to cause pain. But pain may also be felt from injury to the peroneal, posterior tibial or flexor hallucis longus tendons. The area of swelling and tenderness usually indicates which tendon has been damaged.

Treat with rest, ice and anti inflammatories, and see a podiatrist for an evaluation.

Ankle Impingement Syndrome

Anterior Ankle Impingement or Posterior Ankle Impingement Syndrome occurs when soft tissues around the ankle become pinched. When the ankle is bent fully up or down, pain occurs. Runners, footballers and dancers are notorious for developing these syndromes.

Treat as above with tendinitis.

Ankle Sprain

An ankle sprain occurs when the ankle ligaments are subjected to an unnatural twisting, causing stretching or tearing of the ligaments.  A sprain can easily cause pain in the entire area around the ankle, including the heel.

Treatment by a podiatrist is necessary to insure that the sprain heals correctly. Damaged ligaments which are not cared for properly become weak and are more likely to be reinjured and cause long-term problems.

Osteoarthritis

Arthritis can occur in any joint in the body. It's especially debilitating when it takes up residence in the ankle. Due to the inflexibility of the arthritic ankle, arthritis patients are prone to plantar fasciitis.

Rheumatoid Arthritis

This chronic autoimmune disease attacks joints at any point in the body. RA usually starts in the small joints of the hands and feet, and progresses to the larger joints. More than 90% of Rheumatoid Arthritis patients develop symptoms in their feet and ankles, usually occurring in both feet simultaneously. Difficulty climbing stairs is an early sign that the ankle is beset with RA. Difficulty on uneven ground suggests that the hindfoot - the heel area - is showing signs of the disease. A podiatrist can identify your symptoms and you will be referred to a rheumatologist for treatment.